Discussions of Mental Health Issues for Gender Variant and Transgender Individuals, Friends and Family with posts by NYC Psychotherapist Ami B. Kaplan, LCSW.

The Prevalence of Transgenderism – an update.

by Ami B. Kaplan, LCSW on February 13, 2012

I offered some information about prevalence in a previous post. I am re-posting those studies here with the addition of some new studies, filling in some omissions, adding links where available and adding some new thoughts.

These are studies that observed at least the year 1990 to the present and where prevalence estimates where made. Sorted by the last year of the study (not the publication year).

(Note: N =number of people in the study, MtF = Male to Female, FtM=Female to Male, Prevalence should be read as ‘one in 42,000’)

The Male to Female numbers are much more reliable than the Female to male numbers at this point. Many researchers argue that FtM transgender individuals can live more easily with male gender expression and may present for treatment less.

The incidents of gender variance being reported are more or less increasing over time (see the graph below). Some researchers have noted that reported incidents are higher in cities and in more tolerant cultures.

Gender Variance is extremelty hard to count due to individuals remaining hidden or choosing not to seek any type of treatment because of stigma.

Example – to read the graph below: Horton finds the prevalence of Male to Female transgender to be one in 750 people.

Hi Ami, thanks for this post! I don’t see it referenced here, so I thought I would ask if you had seen the Williams Institute white paper from April 2011, “How Many People are Lesbian, Gay, Bisexual, and Transgender?” I can send you the PDF if you would like. I’m not sure if it’s available online. Their findings indicate a 0.3% rate or 1 in 3,000.

Hi Ted,
Thank you. I did see the paper.
It seems to make estimates (probably good ones) based on the surveys I’d already listed
in my chart (Conway, Reed and Conron) so I thought it would be confusing to include it.

With such a large variation in the proportion of transgender population as indicated in these studies, I find it difficult to be confident in the often stated statistic of 40-45% suicide attempts within the transgender population. Though I empathize with the pain of dealing of internal struggles, as well as family and societal issues that go along with finding one’s authentic identity, I am not sure how a statistic can be so prevalent on suicide attempts when the total population of transgender individuals itself is so controversial. And I have studied statistics for a year at a graduate level.

The commonly cited 40% statistic on suicide attempts is from the National Transgender Discrimination Survey. It is true that they may have worded the question poorly and the people who answered the survey were not a random sample, but it is clear that the rate of attempted suicide is much too high. Even if you cut the number in half, it would be huge.

Virginia Department of Health did a statewide survey, with respondents from both rural and urban areas as well as good representation from different groups across race and economic status. We also found a similar number of suicide attempts at 41%. Similar problems of not being able to do a random sample, but the fact that the number was so similar does not seem to be coincidental. You can view the report here: http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/documents/pdf/THISFINALREPORTVol1.pdf

Ted Heck, did the Virginia state survey word the question differently from the Williams Institute survey? The Williams Institute has been criticized for asking the question in a way that might have ended up including people who self-harmed.

Also, do you know if the Virginia survey asked people when they attempted suicide relative to when they transitioned, either socially or medically? Another problem with the Williams Institute survey is that people who had transitioned had a higher rate of suicide attempts, but it wasn’t clear if they had attempted suicide before or after transition.

You’re welcome! If you go to the link I posted above, you can look at the survey questions, starting on p. 48 of the report (p. 50 of the PDF). The questions about suicide are at the bottom of p. 14 of the survey. I don’t know if the Williams Institute question was different from ours since I have not looked at it. We did not ask about whether people attempted suicide before or after beginning transition.

It looks like the question in this survey was similar to the one used in the Williams study, although it also asked more about how many times and how old the person was.

It may be that the rate is lower than 40% – here is what the authors of the report from the Williams Institute said about the wording of the question:

“While the NTDS provides a wealth of information
about the experiences of transgender and gender
non-conforming people, the survey instrument and
methodology posed some limitations for this study.
First, the NTDS questionnaire included only a single
item about suicidal behavior that asked, “Have you ever
attempted suicide?” with dichotomized responses of
Yes/No. Researchers have found that using this question
alone in surveys can inflate the percentage of affirmative
responses, since some respondents may use it to
communicate self-harm behavior that is not a “suicide
attempt,” such as seriously considering suicide, planning
for suicide, or engaging in self-harm behavior without
the intent to die (Bongiovi-Garcia et al., 2009). The
National Comorbity Survey, a nationally representative
survey, found that probing for intent to die through
in-person interviews reduced the prevalence of lifetime
suicide attempts from 4.6 percent to 2.7 percent of the
adult sample (Kessler et al., 1999; Nock & Kessler, 2006).
Without such probes, we were unable to determine the
extent to which the 41 percent of NTDS participants
who reported ever attempting suicide may overestimate
the actual prevalence of attempts in the sample. In
addition, the analysis was limited due to a lack of
follow-up questions asked of respondents who reported
having attempted suicide about such things as age and
transgender/gender non-conforming status at the time
of the attempt.”

However, even if you cut the 40% figure in half, it’s way too high and much higher than the general public.

I really wish we could get some surveys where people are asked about where they were in their transition when they attempted suicide. At this point, we don’t have a lot of proof that transition reduces the suicide rate, so it’s important to ask the question.

to Joe’s comment…it is true that the “population” itself is entirely controversial as we see the prevalence ratios get smaller and the overall estimates of the size of the population increasing with each new study, from Horton and Conway both released studies in 2001 with big differences and then in 2010 with Conron, the estimates of the population were huge. I think, at least from what I have been reading in many of these studies are that the estimates are derived from people that self-label as being transgender or however they identify across the sometimes complex spectrum of gender. For myself this road has been a long journey and while not “fully transitioned”, I have been on hormones for 10 years….Although I have at times loaded the gun or bought the rope and made the noose, hung it…. that process alone is quite heavy, feeling burdened as one is walking those seemingly final steps toward the end…..I quite often deal with more suicidal ideation than actual attempts and find after talking with several people in support groups here in the Bay Area as well, that many experience the same ideation more so than actual attempts. I would actually rate ideation as immensely higher, probably twice as high as actual attempts…..but even then, that % is still off the charts. They key toward lowering this number is acceptance, rights, a decrease in discrimination and overall just caring for people. Its the feeling of being alone in this struggle that forces so many of us into the isolation and the low moments. Even in the Bay Area, a so called oasis for transgender people, there are still way too many challenges.